Brief review
*Title:
Decompression and Coflex interlaminar stabilization compared with decompression
and instrumented spinal fusion for spinal stenosis and low-grade degenerative
spondylolisthesis
:two-year results from the prospective,
randomized, multicenter, Food and Drug Administration Investigational Device
Exemption trial.
요추 협착증과 낮은 단계의 퇴행성 척추전방전위증 치료를 위한 감압술 & Conflex(고정체)를 이용한 추궁간판 안정화술과 감압술 & 요추유합술 비교.
:전향적, 무작위배정, 다기관, FDA-IDE연구
*Authors: Davis RJ, Errico TJ, Bae H,
Auerbach JD.
*Bibliography: Spine (Phila Pa 1976). 2013Aug 15;38(18):1529-39.
STUDY
DESIGN
Prospective, randomized, multicenter, Food
and Drug Administration Investigational Device Exemption trial (FDA- IDE)
OBJECTIVE
To
evaluate the safety and efficacy of Coflex interlaminar stabilization compared
with posterior spinal fusion in the treatment of 1-
and 2-level spinal stenosis and degenerative spondylolisthesis.
SUMMARY
OF BACKGROUND DATA
Lumbar fusion for stenosis and degenerative
spondylolisthesis have led to the search for motion-preserving, less-invasive
alternatives.
METHODS
▶Subject: total 322 patients (2006~2010)
-Randomized to receive laminectomy & Coflex interlaminar stabilization(215)
or laminectomy
& posterolateral spinal fusion(107) -->2:1 ratio
▶Evaluating methods: ODI, reoperations, complications, postoperative
epidural injections
RESULTS
▶Follow-up: 95.3% (Coflex) / 97.2% (fusion) –min 2 yrs.
▶Results:
-Operative times: conflex < fusion
- blood loss: conflex < fusion
- length of stay: conflex < fusion
-ODI improvement: conflex > fusion
-VAS improvement: both groups
-SF-12 improvement: conflex > fusion
-Zurich Claudication Questionnaire
-Reoperation rate: conflex (10.7%) >
fusion (7.5%) (p = 0.426)
-Overall success rate: Coflex (66.2%) > fusion
(57.7%) (p = 0.999) -Based on the FDA.
>Coflex significantly improve in all
outcomes measures compared with fusion: symptom severity (p = 0.023); physical function (p
= 0.008); satisfaction (p = 0.006)
>At 2 yrs, fusions increased angulation
(P = 0.002) and a trend toward increased translation (p= 0.083) at the superior adjacent level. Whereas Coflex maintained
normal operative and adjacent level motion.
CONCLUSION
Coflex interlaminar stabilization is a safe
and efficacious alternative compared with lumbar spinal fusion for spinal stenosis
and low-grade spondylolisthesis.
